Provider Demographics
NPI:1457781577
Name:MAFFETT, MARJORIE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:MAFFETT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 SW GREENBURG RD
Mailing Address - Street 2:410
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5410
Mailing Address - Country:US
Mailing Address - Phone:503-517-8555
Mailing Address - Fax:503-517-8556
Practice Address - Street 1:10300 SW GREENBURG RD
Practice Address - Street 2:410
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5410
Practice Address - Country:US
Practice Address - Phone:503-517-8555
Practice Address - Fax:503-517-8556
Is Sole Proprietor?:No
Enumeration Date:2013-11-26
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15199235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist